MEDICARE: MERSEDES ALANE LEWIS MS, LPC CANDIDATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPCCANDIDATE13316	OK

General Provider Information

NPI Number	:	1497682298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERSEDES ALANE LEWIS MS, LPC CANDIDATE

Provider Business Mailing Address
First Line	:	124 E MAIN ST STE B4
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-5623
Country	:	US
Telephone Number	:	580-436-7206
Fax Number	:	580-272-5757

Provider Business Practice Location Address
First Line	:	710 COLONY DR
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2297
Country	:	US
Telephone Number	:	580-436-7206
Fax Number	:	580-272-5757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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